This application allows the principal investigator or the lab technician to log their monthly contamination surveys
in compliance the TTUHSC and Department of Safety Services Radiation Division requirements.

Fill out the information listed in the Laboratory Information section. Once you have completed that section, fill out
the results of your swipes for each zone listed in the swipes and survey detector section. Click the "Submit" button
once you have finished. You will be presented with a PDF document that you will print and keep in your Monthly Contamination Survey
Log Book. Keep your log book handy. You will be asked to present this book during laboratory inspections.

Laboratory DataPrincipal InvestigatorWho is the person in charge of your lab (Last, First Name)?Lab NumberWhat is the number of your lab?Technician NameWho are you (Last, First Name)?Date Swipes TakenWhen did you perform your monthly contamination survey?Background CPMNeeded to calculate net CPM for each station.Instrument Make / ModelWhat did you use to make your swipes?Serial NumberSerial number of the intrument you listed above.Calibration DateWhen was the instrument you listed last calibrated professionally?

Download A Copy For Your Records

A notification that this form was completed was sent to Safety Services Personnel. Click the "Download File"
button below to receive a printable document that you will keep in your Monthly Contamincation Survey Log Book.

You will be asked to produce your log book during laboratory inspections.